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Oral Parity

The way we treat cancer is changing. For decades, intravenous (IV) delivery was the primary method for administering the medications used to treat cancer. But today, more and more cancer medications come in the form of a pill and are taken orally.

Typically, cancer medications that are administered intravenously are covered under a health plan’s medical benefit. For many patients, this means having to pay a moderate co-pay or, in some cases, no cost-sharing at all for the medication.

But in contrast, cancer medications that are taken by mouth are usually covered under a health plan’s pharmacy benefit. When it comes to cancer medications, pharmacy benefits typically require the patient to cover a percentage of the drug’s overall cost. Since cancer drugs are typically very expensive, this type of cost-sharing creates serious barriers to care for patients needing an oral medication to treat their cancer.

Why does this matter?

Today, oral medications are crucial in the treatment of many cancers, and their importance is expected only to grow: it’s estimated that up to 30% of the cancer drugs under development today will be oral treatments.

The solution

LLS strongly supports a policy called “cancer treatment fairness” – or “oral parity” – which requires health plans to ensure that patients being treated for cancer do not pay more for an oral medication than for one administered by IV.

43 states and the District of Columbia have passed oral parity legislation limiting patient out-of-pocket costs for the oral medications used to treat cancer, and legislation has been introduced in Congress to extend this vital protection to the 100 million people covered by federally-regulated private insurance plans.